CARE Court, like all of California’s recent mental health-related policy changes, has been touted as an answer to the state’s chronic homelessness crisis. 

The new judicial division will handle mental health cases, getting people into treatment and housing and – theoretically – off the streets. The vast majority of the state has yet to start the program, which was passed into law via the CARE Act and signed by Gov. Gavin Newsom in 2022.

Stanislaus County is among seven counties that launched almost a full year early, serving as a pilot for the rest of the state to learn from before mass implementation. Combined with the recently passed Prop. 1 and an expansion of conservatorship laws, CARE Court signifies a major shift in the state’s approach to mental health services.

County officials caution that the program’s scope, given the specific diagnosis requirements and other criteria, is limited by design. 

“(CARE Court) is promising; it’s a piece of the puzzle. But it isn’t the solution,” said Stanislaus County Assistant Chief Executive Ruben Imperial. “I think at times people thought it was a silver bullet (for homelessness). But I think aligned with all these other reforms regarding mental health care and substance use disorder care it is definitely changing the local systems of care dramatically.”

So, now that it has been up-and-running through Stanislaus Superior Court and Behavioral Health and Recovery Services in Modesto for more than six months, what has the program accomplished so far?

A look at CARE Court’s promise and reality before it rolls out across the state later this year. 

What is CARE Court?

Community Assistance, Recovery and Empowerment (CARE) Court creates a new civil judicial division that handles petitions to get people with untreated schizophrenia spectrum and other psychotic disorders into county treatment programs. These individuals can be housed or unhoused. People with only substance use disorders, depression or other mental health issues do not qualify for CARE Court. 

Schizophrenia and other psychotic disorders remain relatively rare. The National Institute for Mental Health estimates  0.25% and 0.64% of the overall United States population has the disorder. According to the U.S. Department of Housing and Urban Development, California had about 181,000 unhoused residents last year. 

Why have some counties, like Stanislaus County, started it already?

Stanislaus is one of seven counties that started the CARE Court pilot programs Oct. 1, 2023. The other counties are Tuolumne, Glenn, San Francisco, Orange, Riverside and San Diego. Los Angeles County has since launched its CARE Court as well. The remaining 50 counties must implement their programs by December 2024. 

How many people have filed petitions in Stanislaus County so far?

As of April 30, Stanislaus County officials have received 36 petitions, according to Imperial.   

Of those, 10 were dismissed as not eligible for the program. Twelve have entered into voluntary agreements with Behavioral Health & Recovery Services (BHRS). One has proceeded to the plan phase, meaning the parties could not reach a voluntary agreement and the individual was moved onto a court-ordered and monitored treatment plan. The remainder are in the early stages of the process. 

How many people were projected to file petitions during the one-year pilot program?

State officials projected around 100 petitions would be filed in the program’s first year. Imperial said the county’s internal numbers projected from 90 to 120 petitions annually. The actual number of petitions filed falls below the project rate in Stanislaus, with similarly low initial numbers reported across other counties in the pilot program. Statewide CARE Court was projected to help about 12,000 people in its first year. 

But Imperial said the county isn’t worried about the numbers, especially in the program’s inaugural year.

“These people are homeless and to take 12 individuals off the street that were in that really disparate situation in their life, that is success,” he said. “It doesn’t seem like a large number for our county, but when you’ve got about 100 people who qualify for the program and in the first few months you’ve got about 10% of them already housed in boarding care and treatment. You know, that’s a pretty promising number for us.”

How often does CARE Court meet?

Officials initially planned on CARE Court proceedings being held twice a week. Currently, members of the team including the judge, treatment providers and public defender meet once a week on Mondays to look over new or existing cases. 

How much does CARE Court cost locally?

Stanislaus is receiving $3.7 million from the state for planning and implementation. As of this March, the program has spent a net $1.1 million, including about $1 million in direct services through county Behavioral Health and Recovery Services. The program also spent about $31,000 on public defender services and $51,000 on county counsel work on its judicial side. 

Who is staffing CARE Court?

Fifteen new staff members, largely working for BHRS, were hired to staff CARE Court in Stanislaus County, according to county CARE Court manager Chandra Campbell.

Their job classifications are: mental health coordinator, psychiatric nurse, administrative clerk, staff services analyst, mental health clinicians, behavioral health specialists, peer support specialist, software administrator and confidential assistant. 

Imperial said the county may look at staffing levels after the pilot program finishes to determine if the number of employees is warranted moving forward. Staffing at current levels is expected to cost about $2.1 million annually. 

On the judicial side, Superior Court Judge Ruben Villalobos oversaw the launch of CARE Court and its first few months. Currently Superior Court Judge Marcus Mumford now presides over the program. 

Who is filing most of the petitions?

Staff members with Stanislaus County Behavioral Health and Recovery Services have filed the majority of the petitions so far, followed by law enforcement, Imperial said. BHRS staff filed more than 50% of petitions, which Imperial said suggests the individuals had contact with public health care systems before but were not in treatment. 

Petitions can be filed by family members (spouse, parent, child, sibling, grandparents), first responders (police officers, fire fighters, paramedics, mobile crisis response or outreach worker), licensed behavioral health professionals, hospital directors, directors of public/nonprofit organizations providing mental health services, directors of county behavioral health services, public guardians, directors of adult protective services and roommates. Individuals may also self-refer. 

What happens after a petition is filed?

The judge overseeing CARE Court will first look at the petition to determine if the individual is eligible for the program. If the person (called a respondent) qualifies, the next step is for staff from Stanislaus BHRS to make contact with the individual. 

Staff will then work with that person to voluntarily accept treatment, which is called an agreement. That includes having assessments and screenings done and working with a treatment team. 

If the respondent declines an agreement, the judge can order the individual into a plan which is monitored by the court. A public defender represents the respondent during this phase. 

Agreements and plans can include treatment and other behavioral health services, medication and housing. Medication can be court ordered, but it cannot be forcibly administered. 

“Our goal is really to connect with folks who are struggling out there that don’t otherwise seek help,” said Kevin Panyanouvong, associate director and chief operating officer of Stanislaus Behavioral Health and Recovery Services. “This is another tool for us to utilize to support the community and family members struggling with their loved ones. Success isn’t just looking at the number of care plans. It’s also looking at the individuals referred to court.”

How many people have been housed through CARE Court?

Of the 13 respondents in agreements or plans, five have been housed in transitional boarding care. Four are living with families. Two are in jail. Two are unhoused. Clients in CARE Court programs have priority for housing, which is paid for by the county (unless the person has a form of income which can cover the housing).

What happens if people don’t follow their agreements/plans?

If a person in an agreement stops accepting treatment and taking part in services, they may be moved into a court-ordered plan. Plans and agreements typically last 12 months with a six-month check-in with the court. After the year, the program can be extended for another year if needed. 

If a person fails in their plan, after two years they may be referred to the conservatorship process. In conservatorship another person is appointed to care for the individual and can involve involuntary treatment and medication. 

Counties face penalties from the state, with fines up to $1,000 a day, if they fail to provide the services ordered by CARE Court including healthcare, housing and other services. 

What is the demographic breakdown of the people in CARE Court?

Unknown. CARE Court proceedings are confidential. Stanislaus County has declined to give any race, gender, age or other demographic information about the people who have had petitions filed against them so far. 

Before its passage, groups opposed to the CARE Act were concerned about potential racial discrimination and disparities in the program. A 2018 study from Rutgers University found that Black patients are more likely to be misdiagnosed with schizophrenia than white patients. 

What were the other arguments against CARE Court?

While groups like NAMI (National Alliance on Mental Illness) California have backed the program, other mental health advocacy organizations like Disability Rights California and Cal Voices, a peer support services nonprofit, opposed the concept. 

Cal Voices Policy Director Clare Cortright said the new program poses several civil rights issues, and could face legal challenges – particularly when individuals fail to comply with court orders or are referred to conservatorship. 

Cortright also said the low initial petition numbers are a sign that the specialized legal division was not necessary, considering most of the qualified respondents are in voluntary agreements instead of court-ordered plans. 

“If it’s really true that we have folks that are unserved or underserved and all they really need is a quiet nudge in the right direction to accept services, then we don’t need the expensive CARE Court system to do that,” she said. “But it’s just really not true that we have a high number of people on our streets with schizophrenia spectrum disorders who are refusing treatment. It’s just not true.”

What other mental health policy changes has California made besides CARE Court?

In March voters passed Proposition 1, a major overhaul of mental health funding, in addition to $6.4 billion in bonds to build largely institutional treatment and housing facilities. The initiative requires counties to use a third of the funding they receive through the Mental Health Services Act on housing intervention programs, but does not provide additional funding.

Counties are in the process of implementing Prop. 1, which could mean cutting existing services including peer-to-peer support and other early intervention support, to shift funding to housing programs. Counties must have the changes enacted by June 30, 2026.

Last year the Legislature passed SB 43, which expands who is eligible for forced conservatorship under the “gravely disabled” classification. The new law now allows people to be placed in conservatorship because of severe substance abuse disorder without an accompanying mental health diagnosis. 

Those with existing mental health disorders can also be placed in conservatorship under additional criteria that now defines being “gravely disabled.” The changes all give officials greater leeway in who can be placed in involuntary short-term psychiatric holds, longer detention and treatment programs. Counties have until January 2026 to comply, though Stanislaus County plans to have the changes completed by January 2025. 

— Marijke Rowland is the senior health equity reporter for the Central Valley Journalism Collaborative, a nonprofit newsroom which publishes The Merced FOCUS, in collaboration with the California Health Care Foundation (CHCF).